So how does it feel to travel a hundred or more years back in public health history?
The COVID-19 coronavirus, an emerging pandemic, takes us back. It transports us to a time when there were no available antibiotics, virtually no vaccinations, and more limited medical-care interventions.
Since treatment of infectious diseases was so limited, public health measures and strategies to prevent and contain diseases were what we primarily relied upon. For now, this public health approach of a century ago is all we can employ to contain the coronavirus, a virus without a specific antiviral medication to treat it or a vaccination to prevent it.
COVID-19 is a novel virus that is 20 times more lethal than influenza and is now on every continent except Antarctica. Compared with the MERS and SARS coronaviruses, this coronavirus will probably be much more difficult to control. As of this writing, the number of illnesses is escalating rapidly, with almost 100,000 reported cases and more than 3,000 deaths worldwide, with underreporting likely.
Public health officials expect that we have not seen the worst of this pandemic. Although few cases have been identified in America, it is anticipated that intensification will occur in the United States as person-to-person community transmission increases.
A long incubation period of up to 14 or more days, spread of infection from asymptomatic infected individuals, and a high mortality rate make this virus especially worrisome. However, remember that most infections are relatively mild and not life-threatening.
Medical scientists are now exploring possible effective antiviral medications. A vaccine will take a year or more to develop. Therefore, the public health measures we will use in the meantime are containment through quarantine of exposed people; isolation of infected individuals; border and travel restrictions; disease screenings; social distancing; public education, especially pertaining to personal measures to help prevent transmission; surveillance; and diagnostic testing.
This latest health threat should be a reminder of the value of supporting public health on the federal, state and local levels. The very success of public health—the absence of diseases that once routinely killed healthy people—has rendered public health interventions invisible and taken for granted by the public and government. These interventions involve advancements in sanitation, housing, food protection, nutrition, clean water, pure food and drug legislation, antibiotics and vaccination.
Historically, we have woefully underfunded federal, state and local health departments. The Trump administration recently reduced Centers for Disease Control and Prevention funding. Indiana ranks 49th in public health funding, with the Indiana State Department of Health spread thin and most local health departments lacking adequate infrastructure and personnel. The state does have sufficient resources for COVID-19 crisis planning and is preparing with local health departments, hospitals and other entities. But the capacity to optimally respond to a public health crisis is something different.
Indiana and most states will need significant federal assistance and leadership. The Trump administration was slow to intervene in the COVID-19 threat, then President Trump politicized what should be a bipartisan issue. We can only hope Vice President Mike Pence, not highly enlightened in public health matters but now in charge of the federal government’s coronavirus response, will leave the decision making to federal public health experts.
And what about those anti-vaccine advocates among us? Will they refuse a COVID-19 immunization when available? I wonder.•
Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to firstname.lastname@example.org.
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